The development of surgical technique for blending the lid-cheek junction in lower blepharoplasty / 中华整形外科杂志

Traditional blepharoplasty has a role in improving pseudoherniation of orbital fat. However, it ignored the deep lid-cheek junction, which is a significant periorbital changes associated with aging. With the enhanced understanding of the anatomy of the lid-cheek junction, multiple techniques have developed to address how to blend the lid-cheek junction. The aim of this review is to provide current evidence on various techniques used to obtain a youthful lid-cheek junction and to show the role of blending the lid-cheek junction in modern lower blepharoplasty.

Advances in the treatment of infantile hemangioma with topical therapy / 中华整形外科杂志

The incidence of infantile hemangioma (IH) is relatively high, resulting in the necessity of early treatment. Topical medicine is safer than oral administration. This paper reviews the main topical drugs for IH and related mechanism, current situation and the prospect of topical beta blockers for IH.

Advances in intralesional injections for infantile hemangioma / 中华整形外科杂志

Intralesional injection is a common method among various therapeutic choices for the treatment of Infantile Hemangiomas. This article reviews the clinical application of intralesional injections for infantile hemangiomas, discusses indications for intralesional injection treatment and evaluates the safety and efficacy of different injected drugs.

Correction of palpebral bags and tear trough deformity by orbital fat repositioning through premaxillary and prezygomatic space with intraoral fixation / 中华整形外科杂志

Objective@#To explore and evaluate the approach of fat repositioning into premaxillary and prezygomatic spaces combined with intraoral fixation in transconjunctival lower blepharoplasty.@*Methods@#17 patients (2 males and 15 females) who underwent this approach from Aug, 2018 to Feb, 2019 were reviewed. Their average age was 36.88±8.80 years old (range, 24 to 55 years old). A 1.0-1.5 cm transverse transconjunctival incision was made. After blunt dissection of premaxillary and prezygomatic spaces, orbital fat were released and sutured with 1-2 absorbable sutures. Via the guidance of astraight needle through the a forementioned spaces, a small incision was made at the upper vestibular labial side. The orbital fat was pulled down according to the consensus between surgeon and patient and fixed upon the small intraoral incision. All incisions didn′t need to be sutured.@*Results@#The mean follow up was 3.53±1.71 months (range, 1 to 6 months), transconjunctival and intraoral incisons healed well. Palpebral bags and tear trough deformity were obviously improved. Postoperatively, 2 patients felt a transient tractive feeling in the midface region 1 week after surgery, which spontaneously recovered within 1 to 2 weeks. One patient had red, swollen and painful skin beside the right nasal alar one month after the operation, and the symptoms disappeared after 3-day intravenous infusion of cefradine. No lower eyelid retraction, ectropion, hematoma and other complications were observed.@*Conclusions@#This novel approach can achieve periorbital rejuvenation and improve the contour of the lower eyelid and mid-face for patients of all the ages with eyelid bags, tear trough deformity, and midfacial depression, but without severe skin laxity.

Correction of palpebral bags and tear trough deformity by orbital fat repositioning through premaxillary and prezygomatic space with intraoral fixation / 中华整形外科杂志

Objective@#To explore and evaluate the approach of fat repositioning into premaxillary and prezygomatic spaces combined with intraoral fixation in transconjunctival lower blepharoplasty.@*Methods@#17 patients (2 males and 15 females) who underwent this approach from Aug, 2018 to Feb, 2019 were reviewed. Their average age was 36.88±8.80 years old (range, 24 to 55 years old). A 1.0-1.5 cm transverse transconjunctival incision was made. After blunt dissection of premaxillary and prezygomatic spaces, orbital fat were released and sutured with 1-2 absorbable sutures. Via the guidance of astraight needle through the a forementioned spaces, a small incision was made at the upper vestibular labial side. The orbital fat was pulled down according to the consensus between surgeon and patient and fixed upon the small intraoral incision. All incisions didn′t need to be sutured.@*Results@#The mean follow up was 3.53±1.71 months (range, 1 to 6 months), transconjunctival and intraoral incisons healed well. Palpebral bags and tear trough deformity were obviously improved. Postoperatively, 2 patients felt a transient tractive feeling in the midface region 1 week after surgery, which spontaneously recovered within 1 to 2 weeks. One patient had red, swollen and painful skin beside the right nasal alar one month after the operation, and the symptoms disappeared after 3-day intravenous infusion of cefradine. No lower eyelid retraction, ectropion, hematoma and other complications were observed.@*Conclusions@#This novel approach can achieve periorbital rejuvenation and improve the contour of the lower eyelid and mid-face for patients of all the ages with eyelid bags, tear trough deformity, and midfacial depression, but without severe skin laxity.

Current understanding of the genetics of extracranial arteriovenous malformation / 中华整形外科杂志

Arteriovenous malformation (AVM) is defined as a congenital vascular anomaly that shunts blood from arteries to veins with no capillary perfusion. In some rare hereditary diseases, including capillary malformation-arteriovenous malformation (CM-AVM), hereditary hemorrhagic telangiectasia (HHT), PTEN hamartoma-tumor syndrome (PHTS), AVM is generally considered the characteristic clinic presentation. This review primarily focused on the mechanisms of genetic regulation during embryonic vasculature development, genetic mutations in TGF-beta signaling pathway of HHT, PTEN mutations in PHTS and genetic screening of CM-AVM. In addition, current findings in somatic mutations of extracranial AVM were discussed as well. This review aimed to provide insight into the etiology to help the diagnosis and treatment of extracranial AVM in clinic.

Effects of propranolol and timolol on proliferation and apoptosis of hemangioma stem cells / 中华整形外科杂志

Objective@#To investigate the effects of beta-blocker, propranolol and timolol on the proliferation and apoptosis of hemangioma stem cells (HemSCs).@*Methods@#Different concentrations(3, 30, 90, 150 μmol/L)of propranolol and timolol were added in HemSCs culture respectively for 24, 48 and 72 h, and cell proliferation and apoptosis were detected by flow cytometry. Experimental data were analyzed using SPSS 19.0 software. Statistically significance was determined using Student′s t test. Values of P<0.05 were considered statistically significant.@*Results@#Proliferation assay indicated that different concentrations of propranolol and timolol could inhibit HemSCs proliferation, and inhibition degree increased with increasing concentration. However, the effects of propranolol was slightly stronger than that of timolol at high concentrations (30, 90 and 150 μmol/L), but the opposite was observed at low concentration(3 μmol/L)(P<0.05). The results of apoptosis experiment showed that timolol had stronger effect than propranolol in promoting apoptosis at low concentrations (3 and 30 μmol/L), which was 13.7% and 1.1% higher, respectively.@*Conclusions@#Inhibiting HemSCs proliferation and promoting apoptosis may be one of the mechanisms of propranolol and timolol in treating infantile hemangioma.The specific effects of both varies with the concentration and time.

Treatment of infantile port-wine stains with pulsed dye laser: split lesion randomized comparative study between three sessions and seven sessions / 中华整形外科杂志

Objective@#To compare the safety and efficacy of pulsed dye laser (PDL) with different sessios for the East Asian infants with port-wine stains(PWS).@*Methods@#From September 2016 to September 2017, 24 East Asian infants with untreated PWS, who met the standards of enrollment, received seven treatments by PDL at 2-week intervals and three treatments at 6-week intervals at adjacent locations in each patient 2 months after final treatment. The efficacy outcome was compared with Wilcoxon signed-rank test, while the safety was compared using Fisher′s exact test.@*Results@#Of the 24 patients, 20 completed study. Seven patients had multiple sites, given a total of 62 treated PWS sites. Among the patients, 18 had lesions on the face and 2 on the extremities. The average blanching rate was (43.71 ± 27.16) % and (43.29 ± 31.58) % for PDL treatments with 7- and 3- sessions, respectively (P>0.05). The result was consistent with independent observer assessment judging that the result of 7 laser treatments was equally with that of 3 treatments (r=0.416, P=0.0008). The average grade was 3.58 ± 1.21 and 3.53 ± 1.16 for 7- and 3-sessions. The patients treated with 7-sessions developed a little more side effects than 3-sessions, including residue purpura, pigmentation changes, eczema and dermatitis.@*Conclusions@#After three treatments of PDL, the efficacy may not necessarily increased by more frequent treatments for East Asian infantile PWS.

Vascular anomalies: updates and our understanding / 中华整形外科杂志

We briefly reviewed the most significant advance in the field of hemangioma and vascular malformation from the second half of 2016 to the first quarter of 2018. Breakthroughs in basic research, genetic discoveries and animal model development have significantly contributed to the classification, diagnosis, differential diagnosis, and treatment of vascular anomalies including surgical treatment, endovascular therapies, laser treatment and drug therapies. Here, we have discussed important discoveries and innovative hypotheses in infantile hemangioma, congenital hemangioma, KHE/TA, port-wine stain, venous malformation, lymphatic malformation, arteriovenous malformation and etc. Together, we have proposed future directions to help shaping this field.

Artificial intelligence and machine learning in plastic and aesthetic surgery / 中华整形外科杂志

With the emergence of artificial intelligence and application of Watson Health (International Business Machines Corp, Armonk, N. Y.), more and more medical physicians and researchers attempt to contact with this technology. The purpose of this article is to introduce the modern plastic surgeon to machine learning, a subfield of artificial intelligence. This article provides a brief introduction to background of machine learning and current research and potential projects in the field of plastic and aesthetic surgery.

Correction of superior sulcus deformity and dermatochalasis with autologous fat transferto retro-orbicularis oculi fat (ROOF) through upper blepharoplasty incision / 中华医学美学美容杂志

Objective To investigate an operative method of autologous fat transfer to retro-orbicularis oculi fat (ROOF) through upper blepharoplasty incision for correction of superior sulcus deformity and dermatochalasis,and to evaluate the efficacy and safety of the method.Methods ROOF lies in the lateral supraorbital area.Autologous fat transfer to ROOF through upper blepharoplasty incision was performed in patients selected by examination.The efficacy and safety were evaluated by follow-up study.Results From March 2013 to June 2017,23 selected patients received the treatment with 3 months to 50 months (mean,20.4 months) follow-up.The amount of fat graft for each palpebra was 0.6 to 2.0 ml,and the mean graft amount was 1.4 ml.The superior sulcus deformity improved significantly in 22 (95.7％) cases.All 23 cases achieved significant improvement of dermatochalasis.22 (95.7％) cases were satisfied with the result.No major complications occurred.Conclusions Autologous fat transfer to ROOF through upper blepharoplasty incision is effective and safe in correction of superior sulcus deformity and dermatochalasis,The operative method should be a good choice for selected patients.

SiRNA interference on expression of MrgC and phosphorylation of PKCεin ipsilateral dorsal root ganglion of rats with chronic inflammatory pain / 中国比较医学杂志

Objective To observe the Interference effects of siRNA( small interference RNA) intrathecal injection on the expression of mRNA and protein of MrgC, on PWTs ( paw withdrawal thresholds) and the phosphorylation of PKCεSer729 in ipsilateral DRG( dorsal root ganglion) of rats with chronic inflammatory pain induced by CFA( complete freund’ s adjuvant).Methods 16 health adult male SD (Sprague-Dawley) rats were randomly divided into 2 groups: control siRNA group and MrgC siRNA group, 8 rats in each group.After success of intrathecal catheterization, corresponding siRNA was injected in rats for 4d, once a day, 5μg/d per rat.The model of chronic inflammatory pain was established by CFA (0.1ml per rat) subcutaneously injected into the right hind paw at 4th day post-administration, then two groups were administrated corresponding siRNA on alternate day and executed at the 11th day post-administration.The PWTs were measured at 5 time points of pre-intrathecal catheterization, pre-administration, 4th day post-administration(0h post-CFA injection), 5th day post-administration(24h post-CFA injection), 11th day post-administration(7 d post-CFA injection). The expression of MrgC mRNA in ipsilateral DRG was detected by fluorogenic quantitative PCR, and the expression of MrgC and the phosphorylation of PKCε Ser729 in ipsilateral DRG was detected by immumofluorescence method.Result Compared with 4th day post-administration, PWTs of both two groups at 5th day post-administration decreased significantly ( P<0.01 ) .While there was no significant difference of PWTs between two groups at every detective time point. Compared with control siRNA group, the expression of MrgC mRNA and the rate of MrgC positive cells in MrgC siRNA group both decreased significantly ( P<0.01,P <0.05), whereas the rate of p-PKCε Ser729 positive cells increased obviously ( P<0.05) at 11th day post-administration.Conclusion MrgC siRNA can effectively interfere the expression of mRNA and protein of MrgC in L4-L6 ipsilateral DRGs of rats with chronic inflammatory pain induced by CFA, and the siRNA interference on MrgC can obviously up-regulate the phosphorylation of PKCε Ser729, while it has no significant effect on PWTs of rats.

Combined resection of preseptal fat and partial retro-orbicularis oculus fat: a method for refractory upper eyelid heaviness correction / 中华整形外科杂志

<p><b>UNLABELLED</b>OBJECTIVE To investigate an operative method of combined resection of preseptal fat: and partial retro-orbicularis oculus fat (ROOF) for correction of upper eyelid heaviness, and evaluate the efficacy and safety of the method.</p><p><b>METHODS</b>Preseptal fat lies widely under the orbicularis oculi in the upper eyelid, and retro-orbicularis oculus fat (ROOF) lies in the lateral supraorbital area. Combined resection of preseptal fat and partial ROOF was performed in patients selected by examination. The efficacy and safety were evaluated by follow-up study.</p><p><b>RESULTS</b>From May 2011 to July 2013, 38 selected patients received the treatment with 3 months to 28 months follow up. The heaviness of upper eyelid improved in all cases. One patient developed postoperative hematoma, and another patient had a transient numbness over the lateral upper brow region. 37 patients were satisfied with the result.</p><p><b>CONCLUSIONS</b>Combined resection of preseptal fat and partial ROOF was effective in reducing the heaviness of upper eyelid, without major complications. The operative method should be an important adjunct for selected patients undergoing blepharoplasty.</p>

Lower blepharoplasty with a combination of release and lift of the fascia ligament of orbicularis oculi.

BACKGROUND: The inferolateral orbicularis oculi of the lower eyelid can be divided into 2 layers. The inner layer is a true ligament and referred to as the "fascia ligament of orbicularis oculi." Releasing this ligament can improve the aesthetic result of lower blepharoplasty. METHODS: The anatomy of the fascia ligament of orbicularis oculi was investigated in cadaveric and histologic studies. Additionally, thousand cases of lower blepharoplasty were performed utilizing a combination of release and lift of this ligament from 1996 to 2009. RESULTS: Cadaver study demonstrated the fascia ligament of orbicularis oculi is a distinct fibro-structure. Its origin is from the periosteum of the inferolateral orbital rim and extends superomedially and inserts into the deep surface of the orbicularis oculi at the junction of the muscle's middle and lateral thirds. This ligament is 13.5 ± 2.5 mm in length and 11 ± 2.0 mm in width. In the clinical study, by releasing this ligament, 3 to 6 mm more redundant lower eyelid skin can be removed compared with traditional lower blepharoplasty, which can improve the outcome of periorbital rejuvenation and achieve better long-standing aesthetic results. CONCLUSION: The fascia ligament of orbicularis oculi is a structure connecting the orbicularis oculi to the periosteum of inferolateral orbital rim. The lower blepharoplasty with combination of release and lift of this ligament can improve the outcome of lower blepharoplasty, which is a minimally traumatic procedure with long-standing results of orbital rejuvenation.

The determination and significance of VEGF in the serum of hemangioma patients / 中华整形外科杂志

<p><b>OBJECTIVE</b>Looking for an objective biomedical index to distinguish types and phases of hemangioma in order to provide an objective basis for selecting clinical treatment to hemangioma.</p><p><b>METHODS</b>ELISA (enzyme-linked immunosorbent assay) was used to determine serum VEGF concentration of 15 patients with proliferative hemangioma, 6 with involuted hemangioma, 6 with vascular malformation and 8 infants of the control group.</p><p><b>RESULTS</b>The serum VEGF concentrations of 15 proliferative hemangioma patients were significantly higher than those of involuted hemangioma patients, vascular malformation patients and control group infants. The serum VEGF concentrations of involuted hemangioma patients were a little bit higher than those of vascular malformation patients and control group infants, but without statistic significance.</p><p><b>CONCLUSIONS</b>ELISA could easily and accurately determine the serum VEGF concentration of different types and different phases of hemangioma. The determination of serum VEGF concentration could provide guidance for selecting a protocol of systemic corticosteroid treatment for proliferative hemangioma. Combined with gene expression and distribution of VEGF and its receptors and some other cytokines, the determination of serum VEGF concentration could help elucidate the mechanism of proliferative hemangioma.</p>

Cavernous hemangiomas in infants:a new classification / 中华医学美学美容杂志

Objective Cavernous hemangioma of infant was reported as an obscure diagnosis with the different sensitivity to corticosteroid therapy and various natural courses. Therefore, a clinical studies for the biological classification of deep subcutanious vascular lesions might be needed, which was alluded by Mulliken two decades ago. Methods Infants with cavernous hemangiomas accepted normal system corticosteroid therapy during the first 6 months of life before eight-year-follow-up, which continued until the children were 9 to 10 years old. The expression of PCNA and bFGF, and cellular histological characteristics were observed in 12 cases by biopsy. Results There were two major categories of subcutaneous vascular lesions groups: deep capillary hemangiomas, a lesion regressing slowly, and venous malformation, a lesion growing commensurated with the child. They will be also distinguished on the basis of diverse final treatment results, expression of cellular markers, microscopical characteristics, and physical signs. Conclusion The new classification appears to be helpful to make the choice of therapy for infants with "cavernous hemangiomas" , which is proven to be a terminologic confusion.